Periorbital Edema: A Clinical Spectrum

Abstract

INTRODUCTION : When the ophthalmologist evaluates a patient in the emergency department with a periorbital edema, the first approach should be directed to the distinction between a periorbital/preseptal and an orbital/postseptal cellulitis. The objective examination presents valuable sign that can help in this differentiation. The main causes of cellulitis are bacterial infections, but noninfectious causes can also lead to it. The main purpose of this work is to present 4 clinical cases of patients with the same clinical complaint but whose diagnosis, treatment and follow-up were substantially different.

CASE REPORTS: Two of the clinical cases presented patients diagnosed with a preseptal cellulitis, the first caused by an odontogenic abscess and the other caused by a Kerion celsi (a fungal infection). The last two cases presented patients diagnosed with a postseptal cellulitis caused by a frontoethmoidal mucopyocele and a squamous cell carcinoma of the maxillary sinus. The four patients had different clinical presentation and the medical and/or surgical approach varied among them.

DISCUSSION: Clinical presentation of a preseptal and a postseptal cellulitis varies and these series of cases demonstrate these semiological differences. With them, we demonstrate the variability of diseases that may be associated and present with a periorbital edema. We also enhance the importance of a correct etiologic diagnosis to a correct therapeutic approach and of a multidisciplinary approach of these patients. It is crucial for the ophthalmologist to be aware of all signs and symptoms that the patient presents with, through a complete clinical history and a detailed objective evaluation, allowing the identification of the potentially severe cases, in which an orbital invasion might exist, leading to a correct orientation and proper treatment.